Provider Demographics
NPI:1497266613
Name:WASHINGTON, DENISE (STNA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 CLEARMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-3152
Mailing Address - Country:US
Mailing Address - Phone:330-942-3821
Mailing Address - Fax:
Practice Address - Street 1:490 CLEARMOUNT DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-3152
Practice Address - Country:US
Practice Address - Phone:330-942-3821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH377063581297376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide